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April 20, 2018

Florida Insurance Scheme Defrauded Million$

IPI expert referenced: Merrill Matthews | In The News | Media Hit
  One News Now

By Chris Woodward

It's not every day that a person is sentenced for fraud involving medical clinics, but it's more common than one might think.

The SunSentinel reports 55-year-old attorney Jason Dalley wept in court Monday as a judge sentenced him to spend a year and nine months in prison and pay more than $1.8 million in restitution.

According to The Associated Press, Dalley admitted he was part of a group of clinic owners, chiropractors, and attorneys involved in the scheme. Court records show the fraud involving clinics in Broward, Palm Beach, and Miami-Dade counties brought in at least $23 million from ten insurance companies between 2010 and 2017.

Dalley ran a personal injury and criminal defense law firm in Boca Raton. He pleaded guilty to conspiring to commit healthcare, mail, and wire fraud.

"Florida has been the number-one place for various types of insurance fraud, whether you talk about Medicare, Medicaid, or even private insurance," says Dr. Merrill Matthews of the Texas-based Institute for Policy Innovation.

"The thing that we have found over the years is that the private insurance industry –whether you're talking about health insurance and others – tend to catch these things earlier than Medicare and Medicaid have tended to do," Matthews continues. "So if we were looking at a Medicare or Medicaid article, it would [likely] be $230 million as opposed to $23 million."

One of the things the private sector does is run its claims through various types of algorithms to examine if a particular practitioner is overcharging or doing a whole lot more compared to other practitioners.

"The federal government only recently started doing that," Matthews explains. "It paid all the claims that came in, and if something eventually looked enormous, they might go and investigate. 60 Minutes did a story on this several years ago and they talked to a person who had finally been caught."


 

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